If you cannot access the online or paper forms, contact UMP Customer Service at 1-888-849-3681.

You can fill out this application online and click 'submit' OR download the form PDF (123K), print and mail it to:

Bariatric Surgery Request
Regence BlueShield
P.O. Box 2998
Tacoma, WA  98401-2998

Please do not send any other paperwork or records at this time.

Click here to access the online application